High-risk and silent clonal hematopoietic genotypes in patients with nonhematologic cancer Journal Article
| Authors: | Stonestrom, A. J.; Menghrajani, K. N.; Devlin, S. M.; Franch-Expósito, S.; Ptashkin, R. N.; Patel, S. Y.; Spitzer, B.; Wu, X.; Jee, J.; Vela, P. S.; Milbank, J. H.; Shah, R. H.; Mohanty, A. S.; Brannon, A. R.; Xiao, W.; Berger, M. F.; Mantha, S.; Levine, R. L. |
| Article Title: | High-risk and silent clonal hematopoietic genotypes in patients with nonhematologic cancer |
| Abstract: | Clonal hematopoiesis (CH) identified by somatic gene variants with variant allele fraction (VAF) ≥ 2% is associated with an increased risk of hematologic malignancy. However, CH defined by a broader set of genotypes and lower VAFs is ubiquitous in older individuals. To improve our understanding of the relationship between CH genotype and risk of hematologic malignancy, we analyzed data from 42 714 patients who underwent blood sequencing as a normal comparator for nonhematologic tumor testing using a large cancerrelated gene panel. We cataloged hematologic malignancies in this cohort using natural language processing and manual curation of medical records. We found that some CH genotypes including JAK2, RUNX1, and XPO1 variants were associated with high hematologic malignancy risk. Chronic disease was predicted better than acute disease suggesting the influence of length bias. To better understand the implications of hematopoietic clonality independent of mutational function, we evaluated a set of silent synonymous and noncoding mutations. We found that silent CH, particularly when multiple variants were present or VAF was high, was associated with increased risk of hematologic malignancy. We tracked expansion of CH mutations in 26 hematologic malignancies sequenced with the same platform. JAK2 and TP53 VAF consistently expanded at disease onset, whereas DNMT3A and silent CH VAFs mostly decreased. These data inform the clinical and biological interpretation of CH in the context of nonhematologic cancer. © 2024 by The American Society of Hematology. |
| Keywords: | adult; gene mutation; major clinical study; somatic mutation; janus kinase 2; pathogenesis; follow up; genetic analysis; allele; cohort analysis; genotype; chronic myeloid leukemia; protein p53; chronic disease; hematologic malignancy; myelodysplastic syndrome; proportional hazards model; clonal variation; hazard ratio; chronic lymphatic leukemia; myeloproliferative neoplasm; transcription factor runx1; exportin 1; acute myeloid leukemia; natural language processing; clonal hematopoiesis; data processing; prognosis; human; male; female; article |
| Journal Title: | Blood Advances |
| Volume: | 8 |
| Issue: | 4 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2024-02-27 |
| Start Page: | 846 |
| End Page: | 856 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2023011262 |
| PUBMED: | 38147626 |
| PROVIDER: | scopus |
| PMCID: | PMC10875331 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK authors: Ross L. Levine -- Source: Scopus |
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